We Are Fighting the Wrong People — It's the Fucking System We Need to Worry About

This is Post 1 of a series about Moral Injury in Healthcare. This is a free post. **Reading time:** ~6 minutes

A few days ago, a practitioner posted across multiple Facebook groups.

The post hit as critique in a space where people were trying to organize. Whatever the intent, it pulled focus away from “what do we do?” to “who’s right?”

The post was framed as neutral. Practically helpful, even. Just raising important considerations.

My first reaction was visceral. I wanted to say fuck that shit with my whole heart. A few years ago I probably would’ve posted that as a clap back immediately. But I’m 44 now, so instead, I took a beat to regulate myself.

My second reaction — about twenty minutes later — was more interesting.

Why am I this pissed? What is this actually about?

That’s the post.

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What is moral injury, and why does it matter here?

Moral injury is a clinical term that gets thrown around a lot, but here’s what it actually means:

Moral injury is a wound that happens when:

• You’re required to act against your own values

• You witness harm you can’t prevent

• The system overrides your clinical judgment — repeatedly, with no exit

It’s what happens when you’re a clinician who got into this work to help people, and the healthcare machine — insurance structures, regulatory capture, institutional indifference, scope erosion, the grinding pressure of keeping a practice financially viable — systematically prevents you from doing that while requiring you to show up anyway.

It’s not a hard day. It’s damage to your sense of who you are as a practitioner.

And it makes you angry in a way that doesn’t resolve with rest.

And here’s the part that matters for what happened in those Facebook groups:

Moral injury generates rage proportional to the violation. The bigger the gap between your values and what the system forces you to do, the larger the charge.

But the system doesn’t have a comment section.

The insurance company denying your patients’ authorizations doesn’t have a Facebook profile. The regulatory process eroding your scope of practice doesn’t respond to DMs. The structural forces grinding down this profession are diffuse, slow-moving, and completely unresponsive to your activation.

So the charge finds somewhere else to go.

It goes horizontal.

By “horizontal,” I mean: the nervous system looks for a reachable target, and it picks a peer instead of the system that caused the injury. It’s displacement with a professional veneer.

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What horizontal displacement looks like in a profession:

• Someone offers critique of collective work from a distance (sometimes with good intentions, sometimes not)

• The people in the trenches feel it as an attack and respond like one

• Comment threads erupt — not about the actual problem, but about credibility, tone, who has the right to speak

• Everyone leaves more activated and nothing moves forward

• The people doing the work are now defending themselves instead

• And the actual problem — the thing that actually matters — gets exactly zero useful attention

I’m not diagnosing why the original poster did what she did. Maybe she’s also injured and this is how her rage is currently moving. Maybe she’s genuinely trying to be useful and doesn’t see the effect. Maybe collective hope has been trained out of her and this is what that looks like from the outside.

I don’t know. And for this conversation, it doesn’t matter.

What matters is what happened in your body when you read it. That’s the diagnostic. The body tells you where the charge is trying to go.

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You know your rage went horizontal when:

• Your activation toward a colleague feels bigger than the issue warrants

• You’re tracking the person’s credibility instead of their argument

• You’ve written — or wanted to write — a 400-word reply to a mildly wrong take

• You caught yourself in a private message saying something you’d never say in a room

• You know exactly where the real problem lives but you’re fighting someone who also knows where the real problem lives

• You’re exhausted by your own outrage and can’t find the off switch

• The fight turns inward and suddenly quitting everything feels like the only sane option

I’ve done every single one of these.

This is not weakness. This is not pettiness. This is not you being unprofessional.

This is what moral injury does to a profession when the actual enemy is elusive.

The wound is real. The rage is appropriate. The target is wrong.

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Here’s the uncomfortable part:

The system doesn’t need to engineer this. It just needs to stay elusive long enough for the charge to find a closer target. The math does the rest.

A profession spending its collective energy on internal credibility battles, governance grievances, and Facebook comment threads is a profession not spending that energy on organized advocacy, unified messaging, or coordinated political action.

Divided professions are easier to legislate around. Easier to chip away at. Easier to absorb into other scopes of practice while the practitioners are busy relitigating who has the standing to speak.

The machine doesn’t fear your outrage. It relies on your outrage going sideways.

That’s not a conspiracy. It’s political math. And we keep running it for them.

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We’re not going to fix this by being nicer to each other on Facebook. The wound is too old and the charge is too high for “let’s be collegial” to land.

But we can get better at noticing when the machine is talking through us.

That kind of post didn’t create the rage in those comment threads. The system created it. The post just gave it a target.

The question isn’t whether to be angry. The question is whether your anger is going somewhere that can actually absorb it.

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Do this today: The next time you feel the pull to engage in a professional conflict — online, in a message, in a meeting — before you respond, run this check:

If your body is already gearing up — jaw tight, throat hot, chest forward, fingers moving faster than your thinking — treat that as a flag. Your system is mobilizing for a fight.

Is this the machine talking through me?

Not to suppress the anger. The anger is information. To locate its actual source before you spend it on someone who is probably running on the same moral injury you are.

Then choose: close the tab, or send the reply. But choose on purpose.

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Reply and tell me: where has your professional rage landed lately — and where do you think it was actually coming from?

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